What Is the Gallbladder?
The gallbladder is a small pear-shaped sac that can be found under The liver, which produces bile, which is then stored in the gallbladder. The gallbladder’s function is to excrete bile into the small intestine to help digest fats, allowing easier absorption of fat-soluble vitamins and nutrients into the bloodstream.
“The main function of the gallbladder is to store bile, a fluid made by your liver, which breaks down fats that you eat. After a meal, bile is secreted by the gallbladder when the small intestine secretes the hormone cholecystokinin. The bile flows into the small intestine and helps to digest fats that the foods contain. The gallbladder also acts as a reservoir for the bile that is not being used by the body.”
– Dr Ganesh Ramalingam
What Happens When You Experience Gallbladder Disease?
One of the primary causes of gallbladder diseases is inflammation due to irritation of the gallbladder walls. This is because gallstones block the ducts that lead to the small intestine, causing bile to accumulate and resulting in inflammation.
As a result of gallbladder disease, you might experience the following symptoms:
- Pain – occurring typically in the mid-to upper-right section of your abdomen
- Nausea and Vomiting
- Chronic Diarrhoea
- Jaundice – Yellowing of the skin or whites of the eyes, caused by the excess of the pigment bilirubin
- Discoloured stools or urine – Light coloured stools or dark coloured urine may be observed
If you think that these symptoms look generally similar to other gastric diseases or typical stomach discomfort, you may be right.
“Most patients experiencing pain in their abdomen may not be able to identify the conditions of gallbladder disease immediately. As a result, it is important to look for signs of gallbladder disease or inflammation as they may eventually damage the gallbladder, making it lose its ability to function correctly.”
– Dr Ganesh Ramalingam
Most people can go about their lives normally without even realising they have a gallbladder disease, which in this case, was one relating to gallstones. In 2015, a 70-year-old man removed a gallstone the size of a melon. The condition went unnoticed for decades before it finally detected and removed. By the time of removal, it weighed 1.2kg and was 14cm wide, making it one of the largest gallstones to be removed from a person.
What Is a Gallbladder Infection?
A gallbladder infection, also known as cholecystitis, is inflammation of the gallbladder. This usually occurs when a gallstone blocks the cystic duct, resulting in a bile buildup. This causes inflammation. Other causes of the gallbladder may include excessive alcohol use, infections or even tumours that cause bile buildup.
What Causes Cholecystitis?
Gallstones often cause a gallbladder infection. When cholesterol levels in the blood are too high, this excess cholesterol hardens and turns into stone. This is how the stones develop in 80% of gallstone cases. In the remaining 20% of gallstone cases, gallstones result from the hardening of unusually high levels of a waste product called bilirubin in the gallbladder.
Gallstones may block the cystic duct, which is the tube that bile flows when it leaves the gallbladder, causing bile to build up. This results in inflammation of the gallbladder. In other cases, a gallbladder infection is caused by a tumour. A tumour may prevent bile from draining out of your gallbladder normally. This causes bile to accumulate, which may lead to an infection.
What Are the Symptoms of Cholecystitis?
The risk of developing cholecystitis from symptomatic gallstones is 1 to 3 per cent, and it can be a medical emergency.
The most common symptom of cholecystitis is abdominal pain that is prolonged and can last for several hours. This pain tends to occur in the middle or right side of your upper abdomen. However, it may also spread to your right shoulder or back.
Pain from cholecystitis can feel like a sharp pain or dull cramps. It is often described as excruciating.
Other symptoms include:
- Clay-coloured stool
- Nausea and vomiting
- Fever or chills
- Yellowing of your skin
- Yellowing in the whites of your eyes
- Abdominal bloating
- Pain, typically after a meal
Seek medical attention immediately if these symptoms last more than 1 to 2 hours or if you have a fever.
How Is Cholecystitis Diagnosed?
To diagnose the presence of gallstones and cholecystitis, your doctor will assess you in a physical examination. You may be scheduled to undergo diagnostic imaging tests such as blood tests, ultrasound scan, CT scan, cholangiography and MRI scan to check for abnormalities in your gallbladder.
Blood tests can test for infection or other conditions such as pancreatitis and jaundice, which is caused by gallstones. An ultrasound scan or CT scan provides images of your gallbladder. The doctor analyses the images for signs of gallstones.
Cholangiography is performed by using a dye that shows up on X-rays. The dye may be injected using an endoscope through your mouth, or into your blood or even directly into your bile ducts during surgery. After this, X-ray images are taken. If your gallbladder and bile systems are functioning normally, the dye will be absorbed in specific places.
Otherwise, the images will reveal abnormalities in your bile or pancreatic systems. If a blockage has been detected, an endoscopic retrograde cholangiopancreatography (ERCP) will be carried out.
During this procedure, your doctor removes the blockage using an endoscope. An MRI scan is carried out to check for gall stones in the bile ducts. This scan uses strong magnetic fields and radio waves to produce detailed images of the organs in the body.
What Are the Risk Factors That Cause Cholecystitis?
Dr Ganesh says, “The risk of an individual developing gallstones which leads to cholecystitis are mainly related to their diet and lifestyle. For many, they tend to lean towards a high fat and high cholesterol diet, which may lead to other gallbladder diseases.”
You may be at risk if you:
- Are overweight or obese
- Consume a low-fibre, high-fat and high-cholesterol diet
- Experienced rapid weight loss recently
Other factors that increase your risk of developing cholecystitis are:
- A family history of gallstones
- Birth control pills or hormones
- Liver disease
While most patients who develop gallstones are older females, 35-year-old Will Hodgkinson has a different experience. Will, like most patients, felt a jabbing pain in the stomach and wrote it off as indigestion. But within hours, the pain became severe, and nausea started to set in. He was admitted to the emergency ward of King’s College Hospital, where he was diagnosed with gallstones that have led to cholecystitis.
Within a month, Will was scheduled for laparoscopic Cholecystectomy to have his gallbladder removed.
“Some people who have had the operation do find they feel sick if they overeat fatty food,” the doctor told me. “You also want to be careful not to overeat or have heavy meals. But it won’t affect your lifespan or anything like that. It is quite a big operation – we’re taking an internal organ out, and you’re going to have to take it easy for a while – but in the long run, you’ll be OK.”
Do Gallstones Go Away on Their Own?
Most of the time, patients with gallstones will not need treatment unless it is causing them pain. Depending on the severity of the condition and presence of gallstones within the gallbladder, dietary changes may be the first step to preventing complications.
In serious cases where patients experience severe pain, your doctor will likely recommend surgery.
What Should I Avoid Eating if I Have Cholecystitis?
Avoiding certain foods can help to protect your gallbladder. The biggest problem foods are those that are high in fat and highly processed. Foods that are greasy or fried in oils like vegetable oil or peanut oil are more difficult to break down. This can cause gallbladder problems.
Changing your diet may help improve the condition and reduce the risk of gallstones. You may consider:
- Reducing your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.
- Adding fibre to your diet to make your bowel movements more solid. By adding only a serving of fibre at a time can prevent gas that can occur from eating excess fibre.
- Avoiding foods and drinks known to cause diarrhoea, including caffeinated drinks, high-fat dairy products, and very sweet foods.
- Eating several small meals per day as smaller meals are easier for the body to digest.
- Drinking sufficient amount of water daily.
If you intend to lose weight, do it slowly. Aim to lose no more than one kilogram per week, as rapid weight loss may increase the risk of gallstones and other health problems.
How Is Cholecystitis Treated?
Severe abdominal pain may need immediate treatment. It is recommended that you see your doctor if you begin to have intense, unexplained abdominal pain.
Your doctor may recommend hospitalisation so that you can be monitored. Additionally, you may be asked to fast. Since your gallbladder is part of your digestive system, fasting allows the gallbladder to rest. You may also receive intravenous (IV) fluids to prevent the risk of dehydration. Your medical team will most likely prescribe pain medications and antibiotics to minimise your abdominal pain and fight infection.
Surgery may be recommended to remove your gallbladder if the cholecystitis keeps recurring. This is called a cholecystectomy, which can be done laparoscopically (keyhole surgery).
Laparoscopic Cholecystectomy (or gallbladder removal) is a common surgery used to treat cholecystitis. This surgery is recommended if you have pain or other symptoms from gallstones, or your gallbladder is not functioning normally and requires immediate medical attention.
Laparoscopic Cholecystectomy is done under general anaesthesia. With 3 or 4 small incisions, your surgeon will be able to remove your gallbladder. Patients may be discharged in a day or two after the procedure.
Do note that you may experience loose or watery stools after gallbladder removal. Since removing a gallbladder involves rerouting the bile from the liver to the small intestine, bile no longer passes through the gallbladder, and it becomes less concentrated. This can result in a laxative effect that causes diarrhoea. Eat a reduced-fat diet so that you release less bile as a means of treating this.
What Happens After I Remove My Gallbladder?
If surgery is needed to remove your gallbladder or any stones in your gallbladder, the outlook is often positive. In most cases of stone removal, the gallstones do not recur.
With that said, you do not require treatment if your gallstones do not cause symptoms. You may, however, want to make lifestyle changes to prevent them from getting bigger and causing problems.
Can I Survive Without My Gallbladder?
Sara Meinschein is a busy 21-year-old. While balancing her hectic lifestyle as a student while working as a nurse, Sara started to feel nauseous and experience abdominal pain, but would brush it off as mild indigestion.
For four months, Sara suffered from pain and had several instances of gallbladder attacks. This occurs when a gallstone gets stuck in the bile duct of the gallbladder.
Further investigation revealed Sara had sludge and gallstones in her gallbladder. Ultimately, Sara decided to have her gallbladder removed, and within a week of recovery, Sara’s appetite returned just in time for Thanksgiving.
“I didn’t realise how much pain I was in with the attacks,” Sara says. “I feel so much better now.”
“You can lead a perfectly normal life without a gallbladder. Your liver will still make enough bile to digest your food. However, instead of being stored in the gallbladder, it drips continuously into your digestive system.”
– Dr Ganesh Ramalingam
With that said, there may be some lifestyle changes required to improve your quality of life while helping you ease digestive symptoms such as:
- Adopt a low-fat diet
- Avoid fatty foods
- Eat small and frequent meals
- Avoid eating a large dinner after fasting
Schedule a consult with our doctor Dr Ganesh Ramalingam
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